Preventive care answers and advice

Completing your regular checkup is one of the most important things you can do to manage your health. And, in most cases, your health plan covers the cost of recommended preventive care.

The Affordable Care Act (ACA) ensures that health plans cover most preventive services. We are here to help you get the most value from your plan’s preventive benefits and avoid unexpected costs.

What preventive benefits are covered?

LifeWise follows the ACA guidelines for services that are fully covered, with no out-of-pocket cost to you. The lists of services provided by the ACA are different for adults, women, and children. 

Adult preventive care benefits include:

• Blood pressure screening
• Colon cancer screening, if you’re over age 50
• Type 2 diabetes screening, if you have high blood pressure
• Immunizations
• Screenings for certain sexually transmitted infections (STIs)

Preventive care benefits for women also include:

• Anemia screening
• Breastfeeding support and counseling for women who are pregnant or nursing
• Birth control

Children receive preventive care benefits that include:

• Behavioral assessments
• Blood pressure screening
• Height, weight, and body mass index (BMI) measurements
• Immunizations
• Vision screening

Some preventive services aren’t usually covered

The various fully covered preventive services is one of the biggest advantages to a health plan under the ACA. Knowing that many preventive services are covered, you might not expect to get a bill when you go in for your annual preventive checkup. 

However, your doctor may suggest services that are not included in the lists above, and those will cost you money. They may perform these services without informing you that you’ll pay more. Remember, your primary care provider is focused on your care and often is unaware of the specifics of your plan benefits. 

Addressing concerns that are diagnostic and not preventive may result in an extra charge for an office visit.

Here are some preventive services that may come with extra costs:

• All the covered preventive services if you don’t have risk factors or if your doctor does them more often than recommended.
• Blood tests called a general health panel. This is a set of tests that include your blood count and levels of various minerals and hormones in your blood.
• Vitamin D test. Doctors may recommend a vitamin D supplement if it could benefit you, even without this test. So you may want to consider this route.
• Skin exam or skin cancer screening. Your doctor may recommend this if your exposure to the sun puts you at risk or if you have certain warning signs. But it will still cost extra.
• Adult eye exam (unless you have vision coverage).

Tips to avoid extra costs for preventive care

1. Make sure you see your assigned primary care provider. You can view or change your PCP through your online account or by calling customer service at 1-800-817-3056. 
2. Be clear when you schedule a doctor’s visit by informing them you’re only interested in free preventive services.
3. Ask questions about costs. Don’t be afraid to ask for additional information about costs associated with recommended tests or treatment based on your results.
4. Some plans only cover preventive services 100 percent during your annual preventive checkup. So print this list from Healthcare.gov and use it to make sure you don’t miss anything. Checkout this article for additional tips on getting the most out of your annual preventive checkup: <link to 8 helpful tips to get the most out of your next primary care appointment article> 
5. Make sure your doctor uses a lab that is in your health plan’s network. Sometimes your doctor may send test results to an out-of-network lab. You won’t know unless you ask. To check if a lab is in-network, use the Find a Doctor tool.